Health Information

Does Your camper have ANY condition that would limit participation in all camp activities?
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No Yes

Does your camper have a Valid Illinois Medical Card?
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Yes No

Please upload a picture of the FRONT of your Camper's Valid Insurance/Medical Card:

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Please upload a picture of the BACK of your Camper's Valid Insurance/Medical Card:

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If you were not able to upload the pictures, you will need to SEND a copy of the Front and Back of your Insurance Card PRIOR to Registration.

My Camper can have over the counter medications:
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No Yes

Are Immunizations up to date?
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No Yes

Last Tetanus Booster? (Month/Year)
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Doctors Name or Medical Clinic:
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Doctor's Phone Number:
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Area Code Phone Number

Name of Insurance Company:
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Full Name of Policy Holder:
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Birth Date of Policy Holder
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Month Day Year

Policy Number:
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ID Number:
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If you have one, please type your SNAP and/or TANF Number here:

Consent/Release Form

I, the undersigned parent/guardian hereby consent to my child, who is under 18 years of age, participating in activities connected with CAMP GOOD NEWS® in Washington, IL, an activity sponsored by Child Evangelism Fellowship®. I certify that my child is able to participate in these activities including sports, hiking, ropes course, Zipline, and swimming, etc. (unless otherwise indicated). If there are any activities I do not want my child to be involved in I have listed them. I UNDERSTAND AND HERBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO.

If my child has medical conditions, which may be relevant to a physician in the event of an emergency, I have listed them. In the event that an emergency occurs, I may be reached at the telephone number(s) listed. If I cannot be reached within a reasonable period of time, I hereby authorize the Camp Good News staff to make emergency medical decisions for my child.

I do hereby agree to hold CAMP GOOD NEWS® and its agents and employees, harmless from any and all liability, actions, causes of action, claims, expenses, and damages on account if injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity to participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the State of Illinois law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release and contractual and not a mere recital. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.

Electronic Signature of Foster Parent/Guardian: By entering my name below, I accept the above conditions and releases.
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First Name Last Name

Current Date:
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Month
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Day Year

For Security, type the message seen below:
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Upon completion of filling in all areas of form, click "Submit Form".

Only one camper may be registered at a time.

You may click "Print Form" to print a copy of this form.

If you have questions or need help with online registration? Email Chris at campgn@telstar-online.net.